AB0593 RISK FACTORS FOR HOSPITALIZATION IN SYSTEMIC ERYTHEMATOSUS LUPUS (SLE). WHAT IS AT STAKE IN THE FIRST YEAR OF THE DISEASE?
Authors: D. Schilirò, F. Trentin, V. Signorini, E. Elefante, C. Stagnaro, L. Carli, F. Ferro, D. Zucchi, M. Maffi, L. Gualtieri, A. Valevich, G. Cascarano, C. Tani, M. Mosca
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Several risk factors for hospitalization have been identified among clinical, demographic, and laboratory features in SLE patients. However, less is known about how and how much disease expression in the first year since diagnosis may impact the outcome or predict disease course in the following years. <h3>Objectives</h3> To define early risk factors for hospitalization in SLE. <h3>Methods</h3> Observational, retrospective analysis in a monocentric cohort of SLE patients, regularly followed at our Unit. Demographics, clinical manifestations, hospitalizations over time, SLE flares and treatments at disease onset and during follow-up were collected. In particular, number and type of immunosuppressants (IS), daily and cumulative doses of glucocorticoids (GCs) at o 1 and 5 years of follow-up. Disease activity was evaluated by SLEDAI-2K score at baseline, at 1 and 5 years of follow-up while organ damage was assessed by the SLICC/ACR damage index (SDI). Disease state as modified Lupus Low Disease Activity status (LLDAS) without PGA, was evaluated at one year from SLE diagnosis. T-test and chi square test were used to estimate association between at least one hospitalization within the fifth years of disease and sex, age, and clinical manifestations at disease onset. <h3>Results</h3> Among 422 Caucasian SLE patients regularly followed in our centre, (87% female, mean age 47±13.2 years, follow-up duration 10.5±9.3 years) 263 (62%) had at least one hospitalization due to SLE disease activity or disease related complications within five years from disease onset. Similar hospitalization incidence rate at five years and at the last visit were found (0.19 and 0.21 patient-years respectively). Characteristics of hospitalized patients at 5 years with respect to non-hospitalized ones are reported in Table 1. Disease onset with nephritis or constitutional symptoms (fever, lymphadenopathies) and not being in LLDAs at one year were significantly associated to hospitalization within five years (p values &lt;0.01). Moreover, number of IS, cumulative GC dose at 1 and 5 years and SDI at 5 years of follow-up resulted significantly associated with hospitalizations (p values&lt;0.01). No correlations were found between age at disease onset, sex, diagnostic delay, other manifestations at disease onset, SDI at 1 year and the risk of hospitalization over time. <h3>Conclusion</h3> Hospitalizations for disease activity and its complications are frequent in SLE patients, not only in the first years of the disease. A more aggressive SLE phenotype and treatments at onset are associated with higher risk for future hospitalizations; on the other hand, being on LLDAS within one year from disease onset seems to be protective. Therefore, our data suggest that disease expression within the first year from diagnosis could be crucial to predict SLE course over time and to stratify patients at lower or higher risk for severe disease. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.